True grit: don’t blame the victim, solve the problem

With the debate about whether or not to wear cycle helmets in the news once again, RoSPA asked Carlton Reid, the executive editor of BikeBiz.com and editor of BikeHub.co.uk, to contribute a guest blog.

I’m a pro helmet anti-compulsionist.

I wear a helmet because I’m a mountain biker too and it’s now pretty much standard equipment off-road. I’ve also raced in the past and helmet-use is a requirement for any form of racing. Hopefully, when road riding, I don’t go quicker or more recklessly because I’m wearing a helmet.

My three kids (11, 13 and 11) have always worn helmets and two still do. The third is now getting more fashion conscious and she prefers to wear a hat rather than a helmet. I don’t force the issue, she’s old enough now to realise concrete and tarmac are quite hard and unforgiving.

Cyclists are united by their love of cycling, but are very often divided over the sometimes vitriolic subject of helmets. But I don’t think my bicycle helmet will save my head should I be unlucky enough to be hit by a speeding car.

Polystyrene is tough, but it’s not that tough. Helmet manufacturers are very careful when it comes to claims about the efficacy of their products. They have to be: if they overstated the effectiveness they could be held liable in those cases when, sadly, cyclists have been badly injured or killed while wearing protective head gear.

Most bicycle helmets are designed for falls to the ground from one metre at speeds of 12mph. They offer almost zero protection in collisions between bicycles and fast-moving cars.

Riding safely is the best form of protection.

But the way some in the mainstream media portray bicycle helmets you’d think polystyrene was a magical material with amazing force-field capabilities. It’s very common for news reporters to mention the use – or non-use – of helmets when describing car v bike fatalities. Recently, a TV news report from Carolina in America had this awful headline: “Cyclists involved in deadly accident not wearing helmets”.

The first paragraph of the news story said: “Investigators say Trey and David Doolittle were not wearing protective helmets at the time of the car accident…that killed both cyclists. Highway Patrol Trooper B.R. Phillips says David Doolittle was wearing protective gloves as well cycling shoes and spandex but neither cyclist had on head protection.”

Trey and David Doolittle were killed by a drunk driver, likely doing at least 55mph. The driver did not brake before he hit the cyclists. He would have carried on driving had he not been stopped by a motorist who witnessed the crash. The TV reporter does not reveal how polystyrene would have protected this father and son, out on a training ride.

This media focus on helmets is classic victim-blaming. And it’s not just a media problem. A 2007 study found that motorists give lid-less cyclists more room when passing, suggesting that many motorists believe cycle helmets offer serious protection.

Bicycle helmets are by no means the most important safety intervention. Physical barriers to prevent motorists hitting cyclists, now that’s more like it. But such infrastructure is expensive. It’s far easier and cheaper to focus on making cyclists wear plastic hats rather than build safer routes for cyclists.

In the Netherlands, such separated infrastructure is common and use of helmets for such an ordinary, everyday activity of cycling is negligible. As this video from the winter of 2010 shows, cyclists who fall from their bikes at slow speeds don’t tend to hit their heads. Shot in Lelystad in the Netherlands, cyclist after cyclist in the two minute video falls to the ground when tackling an icy corner. None are wearing helmets.

One woman nearly hit her chin and a few people might have risked wrist damage but, while it’s an unscientific sample, none of the fallen cyclists came anywhere near to hitting their heads. In this particular case, the best safety intervention would have been to spread grit to melt the ice.

Carlton Reid is the executive editor of BikeBiz.com and editor of BikeHub.co.uk, a website for new cyclists funded by a bicycle industry levy fund. He’s also on Twitter.

RoSPA recommends that cyclists wear a cycle helmet that meets a recognised safety standard. Cycle helmets, when correctly worn, are effective in reducing the risk of receiving major head or brain injuries in an accident. They do not guarantee protection, nor prevent accidents from happening in the first place, but wearing a cycle helmet is a simple, low cost and effective way that individual cyclists can protect themselves.

A cycle helmet cushions the head in a fall, providing a last line of defence between your head and the ground. It reduces the force of an impact before it reaches your head and brain. The hard outer shell spreads the force of a blow over a wider area than the initial impact site.

Helmets do not prevent accidents. An accident can still be very serious, even when wearing a helmet. So be just as careful, look around for traffic, dress brightly and follow the rules of the road.

And most importantly of all, RoSPA urges drivers and motorcyclists to ensure they keep a proper look-out for vulnerable road users like cyclists, and to watch their speed, particularly in residential areas and around schools.

You state that “Cycle helmets, when correctly worn, are effective in reducing the risk of receiving major head or brain injuries in an accident.” You do not provide any evidence for this, although there have been many studies over the years. The latest of these, a meta-analysis of 13 studies says in its discussion:

“Do bicycle helmets reduce the risk of injury to the head, face or neck? With respect to head injury, the answer is clearly yes, and the re-analysis of the meta-analysis reported by Attewell et al. (2001) in this paper has not changed this answer. As far as facial injury is concerned, evidence suggests that the protective effect is smaller, but on balance there does seem to be a slight protective effect. The risk of neck injury does not seem to be reduced by bicycle helmets. There are only four estimates of effect, but they all indicate an increased risk of injury. When the risk of injury to head, face or neck is viewed as a whole, bicycle helmets do provide a small protective effect. This effect is evident only in older studies. New studies, summarised by a random-effects model of analysis, indicate no net protective effect.”
Elvik, R. (2011). Publication bias and time-trend bias in meta-analysis of bicycle helmet efficacy: A re-analysis of Attewell, Glase and McFadden, 2001, Accident Analysis & Prevention, 43(3): 1245-1251

They follow this up by saying:

“These findings raise a number of issues. In the first place, why do recent studies show a smaller protective effect of bicycle helmets than older studies? In the second place, should a meta-analysis include all studies or just studies that satisfy certain selection criteria, like those applied in the Cochrane review of bicycle helmets (Thompson et al., 2009)? In the third place, why are the findings of some studies that have evaluated the effects of laws mandating the use of bicycle helmets apparently inconsistent with the findings of studies of the protective effect of bicycle helmets for each user?”

On the third point, the effectiveness of legislation they say:

“Several researchers have been puzzled by the fact that, on the one hand, studies have reported large protective effects of bicycle helmets; on the other hand, studies of the effect of legislation that has been associated with large increases in the rate of helmet wearing have not always shown a clear decline in the number of head injuries among cyclists. There are at least two reasons why even a large increase in the rate of helmet wearing will not necessarily lead to a major reduction of the number of cyclists sustaining head injury. One reason could be selective recruitment, which means that it is the most cautious and safety-minded cyclists, with a lower rate of accident involvement than other cyclists, who first start wearing helmets. If, for example, in a population of cyclists 60% have a 20% lower rate of accident involvement than an average cyclist (i.e., a relative risk of 0.8), and these cyclists start wearing helmets that reduce their risk of head injury by 40%, the total number of head injuries would be reduced by 19% (0.8 × 0.60 = 0.48; i.e., the safe cyclists are involved in 48% of all accidents before starting to wear helmets; this reduces to 0.8 × 0.6 × 0.60 = 0.29; ceteris paribus the number of injuries is reduced by 19%). This is less than one would expect if aggregate effects were strictly proportional to individual effects. In the latter case, one would expect the number of head injuries to be reduced by 0.40 × 0.60 = 0.24 = 24%. If there is very selective recruitment, aggregate effects could be substantially smaller than implied by the individual protective effects of bicycle helmets.

Another possible reason why the aggregate effects of bicycle helmets could be smaller than expected on the basis of individual effects is behavioural adaptation. Once helmeted, cyclists might feel better protected and adopt more risky riding behaviour. While this cannot be ruled out, there is no direct evidence for it and performing a convincing study of such behavioural adaptation would be very difficult. The issue remains unresolved (Robinson, 2007).”

Given these findings, is there any chance that RoSPA will change its advice? I ask this because I feel that your advice is counter-productive. It increases the false perception that cycling is a dangerous activity, thus discouraging just the sort of person that would make cycling a mass participatory, socially acceptable activity.

You also say, in your advice “A cycle helmet cushions the head in a fall, providing a last line of defence between your head and the ground. It reduces the force of an impact before it reaches your head and brain. The hard outer shell spreads the force of a blow over a wider area than the initial impact site.”. Firstly, most modern helmets are polystyrene, therefore not hard. So the final line is simply factually incorrect. This statement also shows a lack of understanding of the mechanisms of traumatic brain injury. Direct trauma is one cause of brain injury, possibly not the most important. Torsional effects can tear blood vessels on the surface of the brain which is much harder to diagnose than a blunt trauma fracture and can therefore have much more serious long-term consequences. The risk of torsional injury, as well as neck injury, is increased by the increased weight of a helmet.

If you are setting yourself up as an expert organisation to give advice to the public, you should firstly get your facts right and secondly back up you advice with relevant research. If you do not, you are performing a disservice to all.

On the whole, the British like every activity to have a set of written and, better still, unwritten rules. For cycling, we have decided that, while being out in “traffic” (cars) is apparently unsafe, the best mitigation is not a collective adjustment of driving behaviour, but instead the need to wear special equipment to undertaske cycling. It’sd the same as the hi-viz argument – if we’re not wearing extra, special clothing, we’re not doing it right.

A friend of mine was recently on Radio 4’s Woman’s Hour talking about female participation in cycling – she summed up the pleasure pretty well: it makes one feel like being a kid again. But, the societal pressure to drrss like a dork to go to the shops is removing that.

I’m with Carlton – I wear a lid a lot of the time on a bike, but not always. I have no doubt as to its likely efficacy – a low speed topple, rather than being wiped out by a car.

It would be better for road safety, I think, if special cothing dor driving were introduced – perhaps people would be less casual with human life than they are with their dress.

Very good article. I’d agree with all of it, I’m pro helmets and wear one 90% of the time (some time it just isn’t practical to have it at the end of some journeys) but they should never be compulsory as this will discourage cycling and the more cyclist they are on the roads the more drivers will take care

safetygonesane,
The telling thing about cycling and helmets is that hardly anyone in the Netherlands wears cycle helmets. Why? Because cycling is safe. Cycling in close proximity to cars in the UK is less safe.
But helmets cannot deflect cars. If they could, I would wear one. I have read quite a lot about cycle helmets and I think I’m no less safe without one. I’m most certainly much more comfortable.

I used to wear a helmet. If I want to wear a hat, I wear a hat, but I don’t wear a helmet any more.

I think RoSPA should concentrate on campaigning vociferously for dedicated cycling infrastructure and 20 mph zones in towns and residential areas. Combined with eliminating rat-running through residential areas, this would help protect all VRUs, particularly children, who as recent research has shown have great difficulty judging accurately vehicle approach speeds above 20 mph. Obviously, these restrictions would need to be enforced rigorously. Ref. Wann et al.

I have to say that your policy statement has been so understated as to be unnoticeable.

Perhaps your publicity officer needs to be given a prod, or a large prod. Publicity needn’t be expensive.
————————-
[quote]
….Road traffic statistics confirm that children up to 15 years old are overrepresented in pedestrian casualties….vehicles traveling faster loom less than slower vehicles, which creates a dangerous illusion in which faster vehicles may be perceived as not approaching. Our results…such that children may not be able to detect vehicles approaching at speeds in excess of 20 mph. This creates a risk of injudicious road crossing in urban settings when traffic speeds are higher than 20 mph. The risk is exacerbated because vehicles moving faster than this speed are more likely to result in pedestrian fatalities….
[endquote]

‘Reduced Sensitivity to Visual Looming Inflates the Risk Posed by Speeding Vehicles When Children Try to Cross the Road’ – Wann et al. 9 March 2011

And your point was about the helmet? Cracked helmets prove absolutely nothing, except that the helmet cracked, which isn’t relevant. Helmets are larger than the head they ostensibly protect, which means they are more likely to come into contact with surfaces that the wearer’s head wouldn’t ever have touched. That increased radius combined with surface characteristics can lend helmets to subject the wearer’s head and brain to dangerous rotational accelerations.

Race riding is typically rather different from normal everyday cycling.

Whether or not I wear a helmet depends on the situation. Bikes with clipless pedals? Yep – I’ll don the polystyrene. Racing? No lid = no race. Pootle to the shops? Probably not wearing a helmet. Trip to the pub? I probably should, but I don’t. Actually I probably should when I walk back from the pub, but that’s another story altogether!

I choose to wear a helmet, most of the time. I don’t worry if I go out without one and I don’t worry if my kids forget theirs. Ellie wore hers today, but only because she forgot her hat. I have no problem with her riding lid-less. It’s her choice, even though she was brought up to wear a helmet when riding.

There are far more dangerous things to worry about than falling from bikes and hitting heads.

As I say at the top of the piece, I’m pro helmet and anti-compulsionist. If push came to shove I’d favour the anti-compulsion angle. I’m well aware that the mere wearing of helmets could make non cyclists not take up cycling, but others may take it up if they feel they’re protected.

The genie is out of the bottle.

My main fear is compulsion. I will fight that tooth and nail, and have done so for many years, as regular readers of BikeBiz.com will know (search on BHIT, or Martlew or Peter Bone).

Those who have asked why RoSPA has no policy on driving helmets or walking helmets have a fair point. Walking and driving are dangerous but but not perceived as such.

RoSPA is very much in favour of encouraging cycling and is opposed to making cycle helmets compulsory for that very reason. Encouraging all road users to use the roads safely is one of our key aims – no matter how many wheels they use.

RoSPA recommends that all cyclists wear a cycle helmet that meets a recognised safety standard. Cycle helmets, when correctly worn, are effective in reducing the risk of receiving major head or brain injuries in an accident.

It is recognised that helmets do not guarantee protection for the wearer, nor prevent accidents from happening in the first place. The most effective ways of reducing cyclist accidents and casualties are to improve the behaviour of drivers, improve the behaviour of cyclists and to provide safer cycling environments. However, wearing a cycle helmet is a simple, low cost and effective way that individual cyclists can protect themselves.

Education and publicity measures to promote the use of cycle helmets should continue.

RoSPA does not believe that it is practical to make the use of cycle helmets mandatory because voluntary wearing rates are too low. Should compulsory cycle helmet legislation be considered in the future, it should be based on evidence that cycle helmets are effective in reducing cyclist casualties, and on evidence that voluntary use is sufficiently high for enforcement of the law to be practical. There may be stronger arguments for limiting mandatory cycle helmet use to child (rather than all) cyclists. As cycling provides health and environmental benefits, the likely effect of such legislation on cycle use should also be assessed .

I agree with Carlton’s sentiments. I also wear a helmet, but am happy to let others make their own choice. In the video, though all do a good job of protecting their heads, one woman comes within a few centimeters of slamming the back of her head, two other women nearly hit the sides of their sculls, a man’s forehead does contact the pavement. In all those falls, a properly fitted helmet would have provided some protection.

As a side note: Did anyone see this video of the Women’s Tour of Flanders which includes film of the damage to Kirsten Wild’s helmet? http://tinyurl.com/3hj7yxj

All to often cycle helmets are put forward as a form of safety panacea which they are not. This has lead to heavy promotion of helmets for cycling which is totally out of line with the risks involved and increasing tendency to blame the victim. The question for RoSPA (an organisation of which I used to be a member) has to be why it has single out cycling? Why is it RoSPA is not recommending the wearing on helmets for activities where head injury is far more common, such as DIY, driving, and walking?

Hoorah for common sense! But, then, tragically, BOOOOO for the RoSPA’s stance on helmets being a Good Thing.

When (Oh when) will organisations like RoSPA realise that they have a major role to play in ENCOURAGING more cycling, by not portraying it as dangerous.

Walking is more or less just as ‘dangerous’ as cycling, per hour spent doing it. Does RoSPA recommend helmets for walking? What about stairs? Many hundreds of people a year die on stairs. Where is the RoSPA line on stair helmets? And what about helmets for cars? The most obvious use-case, the one that least inconveniences participants (you can keep it in your car, along with haircare stuff for avoiding dreaded helmet hair). Let’s see RoSPA support Driving Helmets eh?

Sadly, RoSPA won’t have the courage to make such a call. Just like the AA, or any other organisation. Even though thousands of lives could be saved through use of helmets in cars.

Maybe cyclists are seen as a user group who don’t mind looking like dorks. And yes, it’s mostly about image. Like it or not, people are vain. They care about their appearance. Cue inevitable howls from the vehicular cyclists about “would you prefer dribbling from brain damage or having some messy hair” et al. Irrelevant, because they only speak for lycra freaks and tabard-wearers. i.e. the minority. They LIKE the battle aspect, getting togged up. It’s weird. Europeans and most of the rest of the world think so. UK/USA/Australia/NZ weirdo vehicular cyclists are alone in their strange fetish with protective costume for cycling.

You do not need a helmet because cycling is very, very safe and helmets make no difference in a crash. NZ/Australia’s 20-year failures of helmets laws prove this. The only safety is in numbers, and helmets discourage large numbers of cyclists.